| NPI | 1952306490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA60095612) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 3059) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-07-24 |